Jeffrey A Alexander
Biographic Data
| ID | 247715 |
|---|---|
| NAME | Jeffrey A Alexander |
| GIVEN NAMES | Jeffrey A |
| FAMILY NAME | Alexander |
| SIGNATURE | ALEXANDER J A |
| AFFILIATIONS | University of Michigan |
| ORCID | 0000-0003-0872-7936 |
| VERIFIED | Yes |
| TOTAL WORKS | 30 |
| TOTAL CITATIONS | 38 |
| AUTHOR COUNT | 30 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 1982 |
| LATEST PUBLICATION YEAR | 2019 |
| H-INDEX | 4 |
The perceived importance of intersectoral collaboration by health care alliances
There is growing interest in the use of intersectoral collaboration (e.g., alliances, coalitions, partnerships) to address complex, health‐related issues in local communities. Relatively little empirical research, however, has examined how to foster and sustain collaboration across sectors during later stages of development, despite a recognition that the needs and goals for collaboration may change over time. The purpose of this study was to add…
Hospitals and Health: Psychosocial Aspects
Governance Processes and Change Within Organizational Participants of Multi‐sectoral Community Health Care Alliances: The Mediating Role of Vision, Mission, Strategy Agreement and Perceived Alliance V…
Multi‐sectoral community health care alliances are organizations that bring together individuals and organizations from different industry sectors to work collaboratively on improving the health and health care in local communities. Long‐term success and sustainability of alliances are dependent on their ability to galvanize participants to take action within their ‘home’ organizations and institutionalize the vision, goals, and programs within p…
The Science of Quality Improvement Implementation: Developing Capacity to Make a Difference
BACKGROUND: Quality improvement (QI) holds promise to improve quality of care; however, organizations often struggle with its implementation. It has been recommended that practitioners, managers, and researchers attempt to increase systematic understanding of the structure, practices, and context of organizations that facilitate or impede the implementation of QI innovations. OBJECTIVES: To critically review the empirical research on QI implement…
How Do System-Affiliated Hospitals Fare in Providing Community Benefit
The shift from local, community-based organizations to more complex delivery systems raises questions about the community orientation and accountability of health systems and their affiliates. This study examines whether hospitals affiliated with health care systems are more or less likely to engage in practices that reflect responsibility to their local communities by providing benefits in the form of uncompensated care, community engagement, Me…
What Motivates People to Participate More in Community‐based Coalitions
The purpose of this study was to identify potential opportunities for improving member participation in community‐based coalitions. We hypothesized that opportunities for influence and process competence would each foster higher levels of individual member participation. We tested these hypotheses in a sample of 818 members within 79 youth‐oriented coalitions. Opportunities for influence were measured as members' perceptions of an inclusive board…
Tailoring of Outpatient Substance Abuse Treatment to Women, 1995–2005
BACKGROUND: Tailoring substance abuse treatment to women often leads to better outcomes. Previous evidence, however, suggests limited availability of such options. OBJECTIVES: This investigation sought to depict recent changes in outpatient substance abuse treatment (OSAT) tailoring to women and to identify unit and contextual factors associated with these practices. RESEARCH DESIGN: Data were from 2 waves of a national OSAT unit survey (N = 618 …
The Effects of Governing Board Configuration on Profound Organizational Change in Hospitals
This study extends the literature on governing boards and organizational change by examining how governing board configurations have influenced profound organizational change in U.S. hospitals, and the conditions under which such change occurs. Hospitals governed by boards that more closely resembled a corporate governance model were more likely to experience positive changes such as diversification and merger and less likely to undergo negative …
Status Differences in Cross-Functional Teams: Effects on Individual Member Participation, Job Satisfaction, and Intent to Quit
Cross-functional teams (CFTs) play an increasingly important role in health care. However, despite their potential, CFTs often fail to function effectively. This paper contributes to the literature in medical sociology by examining how the steep and well-defined hierarchy characteristic of the health occupations proves to be dysfunctional in the CFT setting. Previous research has shown that status differences among members of work teams negativel…
Whom Do They Serve: Community Responsiveness Among Hospitals Affiliated With Health Systems and Networks
Background. As the US hospital sector becomes more consolidated, concerns have been raised about whether participation in health systems and health networks may reduce community hospitals’ response to community health needs. Objectives. The following were examined: (1) whether freestanding hospitals and system- and network-affiliated hospitals differed in their level of community responsiveness; and (2) how systems and networks affect the level o…
Why Do Drug Treatment Organizations Use Contingent Staffing Arrangements? An Analysis of Market and Social Influences
Contingent staffing arrangements are defined as conditional and transitory work arrangements. In the drug abuse treatment sector, contingent staffing arrangements have the potential to improve treatment if they are used to increase access to needed services. Alternatively, such arrangements could interfere with the development of consistent, long-term client-staff relationships. Unfortunately, little is known about the consequences of or influenc…
The Ties That Bind: Interorganizational Linkages and Physician-System Alignment
OBJECTIVES: To examine the association between the degree of alignment between physicians and health care systems, and interorganizational linkages between physician groups and health care systems. METHODS: The study used a cross sectional, comparative analysis using a sample of 1,279 physicians practicing in loosely affiliated arrangements and 1,781 physicians in 61 groups closely affiliated with 14 vertically integrated health systems. Measures…
Physician Commitment to Organized Delivery Systems
BACKGROUND: Health care systems have developed many types of contracting vehicles with physicians. The immediate aim of these vehicles has been to foster physician commitment and alignment to the system. The ultimate aim of these vehicles has been to garner managed care contracts, reduce costs, and improve quality. To date, most of these vehicles have failed to improve physician commitment. This may be one reason why the ultimate outcomes have no…
Risk Assumption and Physician Alignment With Health Care Organizations
OBJECTIVES: To examine the association between risk assumption by individual physicians and physician groups and the degree of alignment between physicians and health care systems. METHODS: A cross sectional comparative analysis using a sample of 1,279 physicians practicing in loosely affiliated arrangements and 1,781 physicians in 61 groups closely affiliated with 14 vertically integrated health systems. Measures of physician alignment were base…
Factors Associated With Physician Involvement in Care Management
Appropriate physician and management involvement, as well as financial incentives and useful management information systems may facilitate physician participation in CM activities. Physician involvement in implementation of CM practices appears to be important, whereas their involvement in the development phase may be negatively related to later attitudes and participation. The findings call for a more in-depth understanding of the timing of phys…
Physician and Clinical Integration Among Rural Hospitals
The pressures for closer alignment between physicians and hospitals in both rural and urban areas are increasing. This study empirically specifies independent dimensions of physician and clinical integration and compares the extent to which such activities are practiced between rural and urban hospitals and among rural hospitals in different organizational and market contexts. Results suggest that both rural and urban hospitals practice physician…
The Effects of Managed Care on Administrative Burden in Outpatient Substance Abuse Treatment Facilities
From the Department of Health Management and Policy, The University of Michigan, Ann Arbor, Michigan. The study was supported by grants 5R01-DA03272 and 5R01-DA08721 from the National Institute on Drug Abuse. Address correspondence to: Jeffrey A. Alexander, PhD, Department of Management and Policy, University of Michigan School of Public Health, 109 S. Observatory, Ann Arbor, MI 48109-2029
Nurse staffing patterns and hospital efficiency in the United States
Determinants of Rural Hospital Conversion: A Model of Profound Organizational Change
One widely discussed response to the severe problems faced by many rural hospitals is to convert them into organizations that provide health services other than general, acute inpatient care. This study identifies conversions that occurred nationally from 1984 to 1991. The study also empirically examines the determinants of conversion, using rural hospitals that did not convert (between 1984 and 1991) as a comparison group. The authors examine a …
Determinants of Profound Organizational Change: Choice of Conversion or Closure Among Rural Hospitals
Because of severe operating and resource constraints, many rural community hospitals are confronted with pressures to abandon core strategies related to acute inpatient care. Little is known, however, about why hospitals would choose to convert to organizations that provide non-acute care health services as an alternative to closure. We argue that rural hospitals are more likely to convert when conditions are in place that enable them to make maj…
Multihospital System Affiliation as a Survival Strategy for Rural Hospitals Under the Prospective Payment System
The introduction of Medicare's Prospective Payment System (PPS) has disproportionately increased financial pressures on rural hospitals and posed challenges to the survival of these institutions. Increasingly, rural hospitals are seeking strategies that can enhance their chances for survival in a turbulent and hostile environment. This study examined the survival effects of one such strategy, multihospital system affiliation. Specifically, we ass…
The effect of the social organization of work on the voluntary turnover rate of hospital nurses in the United States
Physician Integration Strategies and Hospital Output: A Comparison of Rural and Urban Institutions
Physician integration strategies are attempts to bring physicians into hospital administration by giving them a role on the hospital board, employing them in administrative or clinical capacities, or expanding the administration issues dealt with by medical staff committees. This study used a production function model to examine whether such strategies affect hospital output, measured as case mix-adjusted discharges. The article hypothesizes that…
Hospital Selection Into Multihospital Systems: The Effects of Market, Management, and Mission
The growing literature on multihospital systems (MHS) has concentrated on assessing system performance without a concurrent examination of the assumptions related to the conditions under which hospitals and systems affiliate with each other. Using a net present-value framework the current study develops and tests a model that explains the entry patterns of hospitals into multihospital systems. Specifically, we assess the role of the hospital's ma…
Collective Bargaining in Hospitals: An Organizational and Environmental Analysis
The adoption of collective bargaining agreements in hospitals is conceptualized as resulting from conditions within the hospital that promote conflict and from social, legal and political constraints external to the hospital. It was predicted that hospitals with collective bargaining agreements would be characterized by greater (1) structural complexity, (2) environmental resource change, (3) environmental slack, (4) regulatory intensity, and (5)…
Status Differences in Cross-Functional Teams: Effects on Individual Member Participation, Job Satisfaction, and Intent to Quit
Cross-functional teams (CFTs) play an increasingly important role in health care. However, despite their potential, CFTs often fail to function effectively. This paper contributes to the literature in medical sociology by examining how the steep and well-defined hierarchy characteristic of the health occupations proves to be dysfunctional in the CFT setting. Previous research has shown that status differences among members of work teams negativel…
The effect of the social organization of work on the voluntary turnover rate of hospital nurses in the United States
What Motivates People to Participate More in Community‐based Coalitions
The purpose of this study was to identify potential opportunities for improving member participation in community‐based coalitions. We hypothesized that opportunities for influence and process competence would each foster higher levels of individual member participation. We tested these hypotheses in a sample of 818 members within 79 youth‐oriented coalitions. Opportunities for influence were measured as members' perceptions of an inclusive board…
Determinants of Profound Organizational Change: Choice of Conversion or Closure Among Rural Hospitals
Because of severe operating and resource constraints, many rural community hospitals are confronted with pressures to abandon core strategies related to acute inpatient care. Little is known, however, about why hospitals would choose to convert to organizations that provide non-acute care health services as an alternative to closure. We argue that rural hospitals are more likely to convert when conditions are in place that enable them to make maj…
Effects of Competition, Regulation, and Corporatization on Hospital-Physician Relationships
Jeffrey A. Alexander, Michael A. Morrisey, Stephen M. Shortell, Effects of Competition, Regulation, and Corporatization on Hospital-Physician Relationships, Journal of Health and Social Behavior, Vol. 27, No. 3 (Sep., 1986), pp. 220-235
Patterns of Decision Making in Multihospital Systems
Governance Processes and Change Within Organizational Participants of Multi‐sectoral Community Health Care Alliances: The Mediating Role of Vision, Mission, Strategy Agreement and Perceived Alliance V…
Multi‐sectoral community health care alliances are organizations that bring together individuals and organizations from different industry sectors to work collaboratively on improving the health and health care in local communities. Long‐term success and sustainability of alliances are dependent on their ability to galvanize participants to take action within their ‘home’ organizations and institutionalize the vision, goals, and programs within p…
Why Do Drug Treatment Organizations Use Contingent Staffing Arrangements? An Analysis of Market and Social Influences
Contingent staffing arrangements are defined as conditional and transitory work arrangements. In the drug abuse treatment sector, contingent staffing arrangements have the potential to improve treatment if they are used to increase access to needed services. Alternatively, such arrangements could interfere with the development of consistent, long-term client-staff relationships. Unfortunately, little is known about the consequences of or influenc…
Nurse staffing patterns and hospital efficiency in the United States
Team Nursing: Professional Coordination or Bureaucratic Control
Team Nursing: Professional Coordination or Bureaucratic Control
Toward an Empirical Classification of Hospitals in Multihospital Systems
Inconsistency and lack of utility in multihospital systems research is often attributable to misspecification of the unit of analysis and lack of generalizability of research findings. The typical, system-level focus takes an "organizations are all alike" approach that masks potentially important variation among constituent hospitals in systems. This article develops and validates a multivariate, empirical typology of hospitals affiliated with mu…
Organizational growth, survival and death in the U.S. hospital industry: A population ecology perspective
Effects of Competition, Regulation, and Corporatization on Hospital-Physician Relationships
Jeffrey A. Alexander, Michael A. Morrisey, Stephen M. Shortell, Effects of Competition, Regulation, and Corporatization on Hospital-Physician Relationships, Journal of Health and Social Behavior, Vol. 27, No. 3 (Sep., 1986), pp. 220-235
Patterns of Decision Making in Multihospital Systems
Collective Bargaining in Hospitals: An Organizational and Environmental Analysis
The adoption of collective bargaining agreements in hospitals is conceptualized as resulting from conditions within the hospital that promote conflict and from social, legal and political constraints external to the hospital. It was predicted that hospitals with collective bargaining agreements would be characterized by greater (1) structural complexity, (2) environmental resource change, (3) environmental slack, (4) regulatory intensity, and (5)…
Hospital Selection Into Multihospital Systems: The Effects of Market, Management, and Mission
The growing literature on multihospital systems (MHS) has concentrated on assessing system performance without a concurrent examination of the assumptions related to the conditions under which hospitals and systems affiliate with each other. Using a net present-value framework the current study develops and tests a model that explains the entry patterns of hospitals into multihospital systems. Specifically, we assess the role of the hospital's ma…
Physician Integration Strategies and Hospital Output: A Comparison of Rural and Urban Institutions
Physician integration strategies are attempts to bring physicians into hospital administration by giving them a role on the hospital board, employing them in administrative or clinical capacities, or expanding the administration issues dealt with by medical staff committees. This study used a production function model to examine whether such strategies affect hospital output, measured as case mix-adjusted discharges. The article hypothesizes that…
Multihospital System Affiliation as a Survival Strategy for Rural Hospitals Under the Prospective Payment System
The introduction of Medicare's Prospective Payment System (PPS) has disproportionately increased financial pressures on rural hospitals and posed challenges to the survival of these institutions. Increasingly, rural hospitals are seeking strategies that can enhance their chances for survival in a turbulent and hostile environment. This study examined the survival effects of one such strategy, multihospital system affiliation. Specifically, we ass…
The effect of the social organization of work on the voluntary turnover rate of hospital nurses in the United States
Determinants of Rural Hospital Conversion: A Model of Profound Organizational Change
One widely discussed response to the severe problems faced by many rural hospitals is to convert them into organizations that provide health services other than general, acute inpatient care. This study identifies conversions that occurred nationally from 1984 to 1991. The study also empirically examines the determinants of conversion, using rural hospitals that did not convert (between 1984 and 1991) as a comparison group. The authors examine a …
Determinants of Profound Organizational Change: Choice of Conversion or Closure Among Rural Hospitals
Because of severe operating and resource constraints, many rural community hospitals are confronted with pressures to abandon core strategies related to acute inpatient care. Little is known, however, about why hospitals would choose to convert to organizations that provide non-acute care health services as an alternative to closure. We argue that rural hospitals are more likely to convert when conditions are in place that enable them to make maj…
The Effects of Managed Care on Administrative Burden in Outpatient Substance Abuse Treatment Facilities
From the Department of Health Management and Policy, The University of Michigan, Ann Arbor, Michigan. The study was supported by grants 5R01-DA03272 and 5R01-DA08721 from the National Institute on Drug Abuse. Address correspondence to: Jeffrey A. Alexander, PhD, Department of Management and Policy, University of Michigan School of Public Health, 109 S. Observatory, Ann Arbor, MI 48109-2029
Nurse staffing patterns and hospital efficiency in the United States
Physician and Clinical Integration Among Rural Hospitals
The pressures for closer alignment between physicians and hospitals in both rural and urban areas are increasing. This study empirically specifies independent dimensions of physician and clinical integration and compares the extent to which such activities are practiced between rural and urban hospitals and among rural hospitals in different organizational and market contexts. Results suggest that both rural and urban hospitals practice physician…
The Ties That Bind: Interorganizational Linkages and Physician-System Alignment
OBJECTIVES: To examine the association between the degree of alignment between physicians and health care systems, and interorganizational linkages between physician groups and health care systems. METHODS: The study used a cross sectional, comparative analysis using a sample of 1,279 physicians practicing in loosely affiliated arrangements and 1,781 physicians in 61 groups closely affiliated with 14 vertically integrated health systems. Measures…
Physician Commitment to Organized Delivery Systems
BACKGROUND: Health care systems have developed many types of contracting vehicles with physicians. The immediate aim of these vehicles has been to foster physician commitment and alignment to the system. The ultimate aim of these vehicles has been to garner managed care contracts, reduce costs, and improve quality. To date, most of these vehicles have failed to improve physician commitment. This may be one reason why the ultimate outcomes have no…
Risk Assumption and Physician Alignment With Health Care Organizations
OBJECTIVES: To examine the association between risk assumption by individual physicians and physician groups and the degree of alignment between physicians and health care systems. METHODS: A cross sectional comparative analysis using a sample of 1,279 physicians practicing in loosely affiliated arrangements and 1,781 physicians in 61 groups closely affiliated with 14 vertically integrated health systems. Measures of physician alignment were base…
Factors Associated With Physician Involvement in Care Management
Appropriate physician and management involvement, as well as financial incentives and useful management information systems may facilitate physician participation in CM activities. Physician involvement in implementation of CM practices appears to be important, whereas their involvement in the development phase may be negatively related to later attitudes and participation. The findings call for a more in-depth understanding of the timing of phys…
Whom Do They Serve: Community Responsiveness Among Hospitals Affiliated With Health Systems and Networks
Background. As the US hospital sector becomes more consolidated, concerns have been raised about whether participation in health systems and health networks may reduce community hospitals’ response to community health needs. Objectives. The following were examined: (1) whether freestanding hospitals and system- and network-affiliated hospitals differed in their level of community responsiveness; and (2) how systems and networks affect the level o…
Why Do Drug Treatment Organizations Use Contingent Staffing Arrangements? An Analysis of Market and Social Influences
Contingent staffing arrangements are defined as conditional and transitory work arrangements. In the drug abuse treatment sector, contingent staffing arrangements have the potential to improve treatment if they are used to increase access to needed services. Alternatively, such arrangements could interfere with the development of consistent, long-term client-staff relationships. Unfortunately, little is known about the consequences of or influenc…
Status Differences in Cross-Functional Teams: Effects on Individual Member Participation, Job Satisfaction, and Intent to Quit
Cross-functional teams (CFTs) play an increasingly important role in health care. However, despite their potential, CFTs often fail to function effectively. This paper contributes to the literature in medical sociology by examining how the steep and well-defined hierarchy characteristic of the health occupations proves to be dysfunctional in the CFT setting. Previous research has shown that status differences among members of work teams negativel…
The Effects of Governing Board Configuration on Profound Organizational Change in Hospitals
This study extends the literature on governing boards and organizational change by examining how governing board configurations have influenced profound organizational change in U.S. hospitals, and the conditions under which such change occurs. Hospitals governed by boards that more closely resembled a corporate governance model were more likely to experience positive changes such as diversification and merger and less likely to undergo negative …
Tailoring of Outpatient Substance Abuse Treatment to Women, 1995–2005
BACKGROUND: Tailoring substance abuse treatment to women often leads to better outcomes. Previous evidence, however, suggests limited availability of such options. OBJECTIVES: This investigation sought to depict recent changes in outpatient substance abuse treatment (OSAT) tailoring to women and to identify unit and contextual factors associated with these practices. RESEARCH DESIGN: Data were from 2 waves of a national OSAT unit survey (N = 618 …
What Motivates People to Participate More in Community‐based Coalitions
The purpose of this study was to identify potential opportunities for improving member participation in community‐based coalitions. We hypothesized that opportunities for influence and process competence would each foster higher levels of individual member participation. We tested these hypotheses in a sample of 818 members within 79 youth‐oriented coalitions. Opportunities for influence were measured as members' perceptions of an inclusive board…
Business (19 works) · Medicine (19 works) · Healthcare Policy and Management (16 works) · Political science (16 works) · Economics (15 works) · Health care (14 works) · Primary Care and Health Outcomes (13 works) · Psychology (12 works) · Nursing (11 works) · Family medicine (8 works)